Summary & Overview
CPT 01716: Anesthesia for Upper Arm and Elbow Biceps Tendon Repair
CPT code 01716 represents anesthesia services for procedures on the upper arm and elbow, specifically for tenodesis or repair of a rupture of the long tendon of the biceps. This code is nationally recognized and plays a critical role in ensuring proper billing and reimbursement for anesthesia care during these orthopedic interventions. The publication provides a comprehensive overview of the clinical context, typical settings, and payer coverage for this code.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will gain insights into the scope of services covered, relevant policy updates, and benchmarks for anesthesia billing in operative settings. The summary also highlights the importance of accurate coding for anesthesia services and outlines the modifiers commonly associated with this code, which are essential for compliance and documentation.
This article is designed to inform healthcare professionals, billing specialists, and policy analysts about the nuances of CPT code 01716, including its clinical application, payer landscape, and related codes. The content is organized to provide clarity on national trends and requirements, supporting informed decision-making in medical billing and policy development.
CPT Code Overview
CPT code 01716 is used to report anesthesia services for procedures involving nerves, muscles, tendons, fascia, and bursae of the upper arm and elbow, specifically for tenodesis or repair of a rupture of the long tendon of the biceps. This code is classified under the anesthesia service type and is typically performed in an operative or procedural setting, such as a hospital operating room. The code ensures accurate billing and documentation for anesthesia care provided during these specialized orthopedic procedures.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting with a rupture of the long tendon of the biceps, often due to trauma or degenerative changes. The patient may have underlying conditions such as osteoarthritis or a history of joint replacement. The procedure is performed in an operative setting, such as a hospital operating room, where anesthesia is administered for tenodesis to repair the ruptured tendon. The clinical workflow includes preoperative assessment, induction of anesthesia, surgical repair, and postoperative recovery.
Coding Specifications
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Modifiers:
Modifier Code Description AAAnesthesia services performed personally by anesthesiologist QKMedical direction of two, three, or four concurrent anesthesia procedures QXCRNA service with medical direction by a physician QZCRNA service without medical direction by a physician -
Provider Taxonomies:
Taxonomy Code Specialty 207L00000XAnesthesiology 367500000XCertified Registered Nurse Anesthetist 207LA0401XPain Medicine (Anesthesiology) -
Specialties Represented:
- Anesthesiology
- Certified Registered Nurse Anesthetist
- Pain Medicine (Anesthesiology)
Related Diagnoses
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M17.10- Unilateral primary osteoarthritis, unspecified knee- Indicates osteoarthritis in one knee, relevant if the patient has musculoskeletal degeneration contributing to tendon rupture.
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M17.11- Unilateral primary osteoarthritis, right knee- Specifies osteoarthritis in the right knee, which may be associated with altered biomechanics affecting the upper extremity.
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M17.12- Unilateral primary osteoarthritis, left knee- Specifies osteoarthritis in the left knee, similarly relevant for musculoskeletal assessment.
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M17.5- Other unilateral secondary osteoarthritis of knee- Denotes secondary osteoarthritis, possibly due to prior injury or surgery, which may impact overall musculoskeletal health.
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Z96.651- Presence of right artificial knee joint- Indicates a history of knee replacement, relevant for surgical risk assessment and perioperative planning.
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Z96.652- Presence of left artificial knee joint- Indicates a history of left knee replacement, also relevant for perioperative considerations.
These diagnoses are clinically relevant as they reflect underlying musculoskeletal conditions or surgical history that may influence the need for tendon repair and anesthesia management.
Related CPT Codes
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01714- Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenoplasty, elbow to shoulder- Related as it covers anesthesia for similar upper arm and elbow procedures, specifically tenoplasty, which may be performed in conjunction with or as an alternative to tenodesis.
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01732- Anesthesia for diagnostic arthroscopic procedures of elbow joint- Used for anesthesia during diagnostic arthroscopy of the elbow, which may precede or follow surgical repair procedures like tenodesis.
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01730- Anesthesia for all closed procedures on humerus and elbow- Provides anesthesia for closed (non-open) procedures on the humerus and elbow, serving as an alternative when less invasive interventions are performed.
These codes are commonly used as alternatives or in sequence depending on the specific surgical approach and procedure performed on the upper arm and elbow.
National Reimbursement Benchmarks
National mean rates for CPT code 01716 show that commercial payers (BUCA average) reimburse at $152.57, while Medicare rates are not available in the input. Among individual commercial payers, Cigna has the highest mean rate at $298.27, followed by Blue Cross Blue Shield at $263.44, and Aetna at $220.83. UnitedHealth Group is notably lower at $65.53.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Aetna exhibits the widest spread ($337.00), indicating substantial variability in contracted rates. Blue Cross Blue Shield and Cigna also show broad ranges ($138.50 and $345.00, respectively). UnitedHealth Group has the tightest range ($24.75), suggesting more consistent rates nationally. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska displays a wide spread in reimbursement rates for CPT code 01716, with Blue Cross Blue Shield showing the largest rate range (75th percentile minus 25th percentile) at $96.73, and BUCA at $155.27. In contrast, Aetna and UnitedHealth Group have minimal rate spreads, both with only a $0.00 difference between the 25th and 75th percentiles, indicating highly standardized rates. Cigna also shows a narrow spread of $8.00. This variation highlights significant differences in payer approaches within the state.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are substantially higher, while UnitedHealth Group and Cigna remain below national means. The table and chart below present the full breakdown of payer-specific rates and percentiles for Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 01716, with a mean rate of $328.00.
- UnitedHealth Group offers the lowest mean rate at $74.78, significantly below both the state and national averages.
- Alaska's mean rates for most payers are notably higher than national benchmarks, especially for Blue Cross Blue Shield and BUCA.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.